D. R. Springs1, G. Ortega2, S. Ajmerji1, A. Nehemiah1, R. T. Green1, L. Wilson3 1Howard University College Of Medicine,Washington, DC, USA 2Howard University College Of Medicine,Department Of Surgery,Washington, DC, USA 3Howard University College Of Medicine,Division Of Surgical Oncology,Washington, DC, USA
Introduction: Breast cancer is the most common non-skin neoplasia in women and has the second-highest mortality rate of cancers that affect women. Although the incidence of breast cancer is lower among Black women than among White women, mortality remains higher among Black women. Biological tumor characteristics such as grade at diagnosis and hormone receptor status have been implicated in this disparity. This study intends to evaluate the outcomes of surgical interventions for invasive breast carcinoma.
Methods: Conducted a retrospective review of a single institution’s breast cancer registry from 1990 to 2013. Data collected included demographics, histological grade, stage, hormone receptor status, therapeutic interventions, recurrence, and survival. Patients with diagnosis of infiltrating carcinoma, who were reported as Black, who were female, and for whom date of diagnosis was before 8/19/2009. The primary outcomes evaluated were five year survival (5YS) and five year disease-free survival (DFS). Group comparisons were conducted between patients who received breast conserving therapy (BCT: lumpectomy, partial mastectomy) and those who received a form of mastectomy (total/simple, radical, or modified radical). T tests were used to evaluate continuous variables, and Pearson’s chi-square test to evaluate categorical variables.
Results: 1164 patients met inclusion criteria. Of those, the mean age at diagnosis was 57.7. 94.4% (1099) had the primary diagnosis of infiltrating ductal carcinoma. 73.7% had surgical treatment, 59.4% had BCT, and 40.6% had mastectomy. 6.5% had tumor evaluated as grade I; 24.7% grade II; 50.9% grade III; 0.6% grade IV. 26.3% were stage 1 at biopsy; 38.0% stage 2; 14.8% stage 3; 2.1% stage 4. Hormone receptor status was evaluated for 531 patients; 64.2% (341) were estrogen receptor (ER) positive; 47.6% were progesterone receptor (PR) positive; 44.8% were both ER and PR positive. 380 patients had unequivocal determination of HER2NEU status: 19.7% (75) were HER2NEU positive. Of the entire cohort, 2.0% were triple positive; 8.4% were ER and PR positive, HER2NEU negative; 8.9% were triple negative. Of the patients who were ER positive, 52.3% (181) had 5YS (P<0.05); 55.5% (137) PR positive patients had 5YS (P<0.001); 60.2% (59) patients who were ER and PR positive, HER2NEU negative had 5YS (P<0.05). 63.9% (324) of patients who underwent BCT had 5YS; 48.9% (216) of patients who underwent some form of mastectomy had 5YS. On analysis adjusted for stage, grade, and hormone receptor status, patients who underwent mastectomy had a decreased likelihood of both 5YS (OR = 0.5, 95% CI: 0.3 – 0.9, P = 0.08) and DFS (OR = 0.5, 95% CI: 0.3 – 1.1, P = 0.5), though the difference is not significant.
Conclusion: No significant difference in 5YS or DFS was observed between the two intervention groups. Future analysis should evaluate the effect of adjuvant chemotherapy and radiation therapy after surgery on survival and recurrence.